Norris- Form 1- 6-23-17FORM 1 STATEMENT OF 2016
Plume print or type your name...else FINANCIAL INTERESTS FOR OFFICE USE ONLY:
sedreas,egnry name, end poaltlon Mbw:
LAST NAME — FIRST NAME — MIDDLE NAME:
Norris Brittany Marie
MAILING ADDRESS :
1183 Violet Street
Received
CITY: ZIP: COUNTY:
Atlantic Beach 32233 Duval
JUN 2 3 2017
NAME OF AGENCY
City of Atlantic Beach
NAME OF OFFICE OR POSITION HELD OR SOUGHT:
COnce of City Clerk
Commissioner Seat 5
You an not limited to Me space on the lines on this form. Attach additional sheets, if necessary.
CHECK ONLY IF Rf CANDIDATE OR ❑ NEW EMPLOYEE OR APPOINTEE
**** BOTH PARTS OF THIS SECTION MUST BE COMPLETED "***
DISCLOSURE PERIOD:
THIS STATEMENT REFLECTS YOUR FINANCIAL INTERESTS FOR THE PRECEDING TAX YEAR, WHETHER BASED ON A CALENDAR
YEAR OR ON A FISCAL YEAR. PLEASE STATE BELOW WHETHER THIS STATEMENT IS FOR THE PRECEDING TAX YEAR ENDING
EITHER (must check one):
Lel DECEMBER 31, 2016 OR ❑ SPECIFY TAX YEAR IF OTHER THAN THE CALENDAR YEAR
MANNER OF CALCULATING REPORTABLE INTERESTS:
FILERS HAVE THE OPTION OF USING REPORTING THRESHOLDS THAT ARE ABSOLUTE DOLLAR VALUES, WHICH REQUIRES FEWER
CALCULATIONS, OR USING COMPARATIVE THRESHOLDS, WHICH ARE USUALLY BASED ON PERCENTAGE VALUES (see instructions
for further details). CHECK THE ONE YOU ARE USING (must check one):
O COMPARATIVE (PERCENTAGE) THRESHOLDS OR 11111' DOLLAR VALUE THRESHOLDS
PART A- PRIMARY SOURCES OF INCOME [Major sources of income to the reporting person- See instructions]
(N you have nothing to report, write "none" or "Wit")
NAME OF SOURCE SOURCE'S DESCRIPTION OF THE SOURCE'S
OF INCOME ADDRESS PRINCIPAL BUSINESS ACTIVITY
Adjective & Co
320 1st Street North, Jacksonville Beach, FL
Advertising & Marketing
Independent Contractor
1183 Violet Street, Atlantic Beach, FL
Graphic Design
PART B -- SECONDARY SOURCES OF INCOME
[Major customers, diens, and other sources of income to businesses owned by Me reporting person - See instructions]
(N you have nothing to report, write'nona' or "Na")
NAME OF NAME OF MAJOR SOURCES ADDRESS PRINCIPAL BUSINESS
BUSINESS ENTITY OF BUSINESS' INCOME OF SOURCE ACTIVITY OF SOURCE
n/a
n/a
n/a
This
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
PART C --REAL PROPERTY [Land, buildings owned by Me reposing person- See instructions]
IN you have nothing to report, write "none' ar'Na')
FILING INSTRUCTIONS for when
and where to file this form are
located at the bottom of page 2.
n/a
INSTRUCTIONS on who must fife
n/a
this form and how to fill it out
begin on page 3.
n/a
CE FORM 1 Esas,e Anwry 1, 201 Continued on — me.0tl' PAGE 1
Inmrraalm ry retesm n Rule sts 202111, FAC.
PART D — INTANGIBLE PERSONAL PROPERTY [Stocks, bonds, certificates of deposit, etc. - Sae instructional
IN you have nothing to report, write "none" or "n/a")
TYPE OF INTANGIBLE BUSINESS ENTITY TO WHICH THE PROPERTY RELATES
fila fila
n/a n/a
PARTE — LIABILITIES [Major debts- See instructions]
(If you have nothing to report, write "none' or "nla")
NAME OF CREDITOR ADDRESS OF CREDITOR
Flagstar Bank P.O. Box 660263, Dallas, TX 75266-0263
PART F— INTERESTS IN SPECIFIED BUSINESSES [Ownership or positions in certain types of businesses - See Instructions)
(If you have nothing to report, write "none" or "Na")
BUSINESS ENTITY # 1 BUSINESS ENTITY # 2
NAME OF BUSINESS ENTITY file fila
ADDRESS OF BUSINESS ENTITY n/a n/a
PRINCIPAL BUSINESS ACTIVITY n/a We
POSITION HELD WITH ENTITY rVa We
I OWN MORE THAN A 5% INTEREST IN THE BUSINESS File n/a
NATURE OF MY OWNERSHIP INTEREST n/a III
PART G — TRAINING
For elected municipal officers required to complete annual ethics training pursuant to section 112.3142, F.S.
❑ I CERTIFY THAT I HAVE COMPLETED THE REQUIRED TRAINING.
IF ANY OF PARTS A THROUGH G ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE ❑
SIGNATURE OF FILER: CPA or ATTORNEY SIGNATURE ONLY
If a cerfified public accountant licensed under Chapter 473, or attorney
Signa tUr In good standing with the Florida Bar prepared this form for you, he or
I sZ���7 I , he must complete the fallowing statement
prepared the CE
Form 1 in accordance with Section 112.3145, Florida Statutes, and the
instructions to the form. Upon my reasonable knowledge and belief, the
disclosure herein is true and wnect.
Date Signed:
CPA/AVOrney Signature:
/23/ 2G1�
Oahe Signed.
FILING INSTRUCTIONS:
WHAT TO FILE: WHERE TO FILE: WHEN TO FILE:
After completing all parts of this form, Includina If you were mailed the home by Me Commission Initially, each local oRrcer/employee, state officer,
sianina and dating it, send back only the first on Ethics or a County Supervisor of Elections for and specfietl state employee must file within
sheet (pages 1 and 2) for filing. your annual disclosure filing, return the form to 30 days of the date of his or her appointment
that location. or of the beginning of employment. Appointees
If you have nothing to report in a particular Local oft/ceralemployees file with the who must be confirmed by the Senate must file
section, write "none or We' in that section(s). Supernsor of Elections of the county in which they prior to cenfirmatlon, even g that is less Nan
Permanently reaMe. (If you do not permanently 30 days from Ne data of their appointment.
NOTE: reside in Florida, file with the Supernsor of the CandWafes must file at Ne same 6me May file
MULTIPLE FILING UNNECESSARY: county, where your agency has its headquarters.) their qualifying papers.
A candidate who files a Form 1 with a qualifying Stall Officers or specified state employees Thereafter, file by July 1 fclowing and, calender
officer is not required to file with the Commission file with the Commission on Ethics, P.O. Drawer year in which they III their positions.
or Supervisor of Elections. 15709, Tallahassee, FL 323175709; physical Finally, file a Poral disclosure form (Form 1F)
address: 325 John Knox Road, Building E, Suite within 60 days of leaving office or employment.
Facsimiles Will not be accented. 2130, Tallahassee, FL 32303. Filing a CE Form IF (Final Statement of Financial
Candidates file this form together with their Interests) does n relieve the filer of filing a CE
a rs Form 1 g the filer was in his or her posNm on
qualifying M g p Pe . December 31, 2016.
To determine what category your position falls
ry PFGE Y
under, see page 3 of instructions.
qE� lW,ebre,n J'm Rule 31 FA e.